Blue Cross Blue Shield of North Dakota Caring Foundation Rural Health Grant Program Funding Period (February 15, 2018 February 15, 2019)

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1 Blue Cross Blue Shield of North Dakota Caring Foundation Rural Health Grant Program Funding Period (February 15, 2018 February 15, 2019) Introduction The Center for Rural Health, University of North Dakota (UND) School of Medicine and Health Sciences is pleased to announce that Blue Cross Blue Shield of North Dakota (BCBSND) Caring Foundation will make funding available for their rural health grant program, with an emphasis on transforming the health and wellbeing of North Dakotans. Vision BCBSND Caring Foundation seeks to support providers a provider is defined as a health care entity that provides services to patients (ex. hospitals, clinics, nursing facilities, public health units, mental health facilities, dental clinics, tribal health facilities, home health agencies, pharmacies, EMS units and other related health organizations) and their communities by offering grants that stimulate new thinking around providers championing physical activity and wellness programs. Financial support, based on established criteria, will be awarded to those applicants whose proposals benefit rural North Dakotans, and their communities, by embracing physical activity and overall wellness. Attributes of the BCBSND Caring Foundation Rural Health Grant Program The BCBSND Caring Foundation seeks projects that demonstrate collaborative efforts involving rural providers and their communities to support physical activity and wellness for all ages. Some examples of possible activities and programs include: Sponsoring a community race, walk, or biking event Providing athletic equipment for a playground, park, school, or daycare Creating a worksite wellness program for its own employees Repurposing a rehabilitation center to a community training center or workout facility Supporting or sponsoring a workshop that focuses on health promotion and physical activity. Each provider awarded a grant for an activity or program, will receive recognition and publicity as a cosponsor, with the BCBSND Caring Foundation Rural Health Grant brand. Specific expectations will be distributed to successful grant recipients once the awards are determined. Financial Award BCBSND Caring Foundation will make funds available in the total amount of $40,000 for this grant program. Individual awards will be made on a competitive basis to successful applicant(s). It is anticipated that 8-16 grants will be awarded in the amounts of $2,500 to $5,000. Additionally, applicants may request funds as part of one grant request for more than one activity/project, as long as all align with the rural health grant program vision. The committee will consider grants of greater amount if an applicant is applying on behalf of a network of health care facilities. Funds will be awarded to grantees on a cost reimbursement basis. Application Process BCBSND Caring Foundation Rural Health Grant Program will partner with the Center for Rural Health (CRH) at the University of North Dakota, School of Medicine and Health Sciences to provide administration of the

2 program. Applicants are asked to submit a complete grant proposal clearly marked UND RFP #BC-2018 to be received via , no later than 5:00 pm CST, Wednesday, January 10, 2018 (no exceptions will be made). The proposals will be reviewed by a BCBSND Caring Foundation and Center for Rural Health review panel, and successful applicants will be notified by the Center for Rural Health by Friday, February 2. Grantees will be selected according to criteria specified by the BCBSND Caring Foundation. Notification to applicants and any correspondence will occur via through Kylie Nissen, Senior Project Coordinator (kylie.nissen@med.und.edu). Complete grant guidance is included in this information, beginning on page 3. Conclusion These grants are designed to help providers champion physical activity and wellness in their communities and/or facilities. The grants will create an opportunity for providers to remain thought leaders in their communities, and address one of the significant issues in our health care system that contribute to increasing health care costs. 2

3 Program Guidance Blue Cross Blue Shield of North Dakota Caring Foundation Rural Health Grant Program - Funding Period (February 15, 2018 February 15, 2019) (Deadline: Received via , no later than 5:00 pm CST Wednesday, January 10, 2018) Program Purpose The purpose of the Blue Cross Blue Shield of North Dakota (BCBSND) Caring Foundation Rural Health Grant Program is to focus on transforming the health and well-being of rural North Dakotans and raise awareness for the need for all ages to engage in more daily, physical activity and overall wellness. The program targets the following primary focus area(s): Activities that endorse and support activity and wellness for all ages Supplies that endorse and support activity and wellness for all ages Programs that endorse and support activity and wellness for all ages Events that endorse and support activity and wellness for all ages Applicants must identify at least one or more of the above mentioned focus areas in their proposal; and may include more than one activity or program, as long as it meets the overall criteria. Proposal Requirements Eligibility A. For purposes of implementing the activities described in the proposal, single health care entities or a network (informal/formal) can involve a variety of organizations, but not necessarily limited to, the following: hospitals, clinics, nursing facilities, public health units, mental health facilities, dental clinics, tribal health facilities, home health agencies, pharmacies, EMS units, and other appropriate health organizations. B. The lead applicant on the proposal must be a provider (a provider is defined as a health care facility hospital, clinic, public health unit, etc.). C. Both established and/or new partnerships/networks are strongly encouraged. If the applicant has had prior working relationships with the identified partner(s) this needs to be described in the grant application. D. The applicant may form a network with organizations that are public or private, for-profit or nonprofit. E. The applicant may be located in an urban or rural area in North Dakota; however, the true benefit of the proposed project and its outcomes must accrue to rural North Dakota residents and communities. For purposes of this program, rural is defined as any geographic area outside of the 3

4 cities of Minot, Bismarck, Grand Forks, and Fargo. A majority of the grant funds must be expended either in a rural area or in a manner that has direct impact on the rural service area. F. Grant awards will be made to one organization (the applicant). The applicant represents either itself in a solo proposal or an entire partnership under a network proposal. That organization must be capable of receiving and administering grant funds. If the proposal involves a network, the applicant is responsible for distributing any funds to the partners listed for their areas of responsibility. Program Funds A. The BCBSND Caring Foundation will make funds available in the total amount of $40,000 for this grant program. The individual awards will be made on a competitive basis to successful applicant(s). Grants will be available for requests in the amounts of $2,500 to $5,000 awards. The committee will consider grants of greater amount if an applicant is applying on behalf of a network of health care facilities. Funds will be awarded to grantees on a cost reimbursement basis. B. The time frame for implementing the individual grants will be 12 months, with a funding period of (February 15, 2018 February 15, 2019). C. Equipment acquisitions are permitted. If funds for equipment purchases are requested, the applicant must demonstrate how such equipment will be used in conjunction with the goals and objectives of the program. D. A direct financial match on the part of the applicant is not required. However, cost participation (e.g. in-kind, physical space, etc.) is strongly encouraged. Please provide details. E. Grant funds are intended to support achievement of program goals and objectives. Therefore, funds cannot be used for independent projects sponsored by individual members. The proposal must demonstrate how all activities interrelate for the general and specific benefit of the identified service area and target population. Scope of Activity A. The proposal must identify at least one of the focus areas to be addressed (i.e. activities, supplies, programs, or events that support and endorse physical activity and indicate the award level being requested; any amount from $2,500 to $5,000). More than one focus area may be targeted. B. Proposal Sections (1) Need Statement (10 points) a. Describe the general activity, programs, initiative or event and how it will help increase, support, and/or recognize daily, physical activity and/or overall wellness. If the program has existed before, explain its origins and impact to date, and include expectations with the new financial support. (2) Project Description (30 points) a. Describe, in appropriate detail, the project, initiative, event or program in detail: goals, key objectives, activities, anticipated outcome, project workflow/timeline, and person(s) 4

5 responsible. Please provide a workplan (see the attached Sample Workplan). b. Describe the target population and target service area of the proposal. c. Describe the measures of success, i.e., what factors/measurements are the triggers of a successful event, initiative, or program. d. Explain the role and responsibility of the network members (if applicable) in accomplishing the goals and objectives. Show how members will collaborate to implement the project. e. Describe the role of the community members and/or the community organizations in the project. How will the community be kept informed? (3) Project Management and Partner Responsibility (15 points) a. Include information on applicant s ability to manage the grant funds (e.g. previous grant project management). b. Describe the current resources, skills, and staffing expertise that will be utilized for the project. (4) Project Sustainability (10 points) a. Describe specifically how the proposed program, event, initiative or project will continue once the grant funding period ends. (5) Evaluation (15 points) a. Describe the method and process measures for assuring that the proposed goals and objectives are achieved by the proposed timeline. b. Describe how you will measure the impact of the proposed project, and what measures of success will be used to evaluate effectiveness. (6) Memorandum of Agreement (MOA) (required for network based proposals) (5 points) a. Provide a MOA stating the role and responsibility of each partner. If resources (in-kind or financial) are provided, describe that contribution. Have each partner organization sign the document. This is intended to help both the grant reviewers and the applicant to understand that all partners are committed to the project and are aware of their role, responsibility on the proposed project. (7) Line Item Budget Worksheet and Budget Narrative (15 points) a. The budget is divided into two parts: 1) line-item budget worksheet; and 2) budget narrative. The worksheet lists costs associated with the proposed budget. The budget narrative is where you describe in detail how the funds requested for each line item will be spent and how the amount was determined. Use your best judgment when projecting expenses (see the attached Sample Budget). Format Maximum application length is ten pages (one side of page) to include budget/budget narrative. If you include appendices, those are not counted against the ten page limit, but please, provide only pertinent information. Minimum 11 font, using Calibri, Times New Roman, or Arial; double spaced; one inch margins. Charts and tables may use no smaller than 10 font. All pages must be numbered. NOTE: In providing charts, graphs, maps etc. make certain that when copied in black and white no information is blocked out or lost. We have seen nicely designed tables that have 5

6 some rows shaded and or colored maps that when copied comes out solid black and the critical information is not available to the reviewer which can detrimental to the proposal. Key Components of Proposal - Checklist (Assemble the proposal in the following order) A. Cover sheet with project name, project focus, UND RFP number #BC-2018 and contact information (applicant organization, lead contact person/title, address, city, county, state, zip, phone, ). (Not included in the 10-page limit) B. Table of Contents (Not included in the 10-page limit) C. Project abstract (maximum length one page, not included in the 10-page limit) o Provide a brief description of the program, project, event, or initiative. o Provide a brief description of the plan to implement the program, project, event, or initiative. o Provide a brief description of what you plan to measure, how you plan to measure it, and the proposed outcome or impact. o State the total dollar amount being requested. D. Proposal o Need Statement o Project Description (including Workplan) o Project Management and Partner Relationship o Project Sustainability o Evaluation E. Signed Memorandum of Agreement between all partners indicated in proposal (not included in the 10-page limit) F. Letters of Support (maximum of two) (Not included in the 10-page limit) G. Budget (Included in the 10-page limit) H. Budget Narrative (Included in the 10-page limit) Submission of Grant Please your proposal to Kylie Nissen at kylie.nissen@med.und.edu. All proposals must be clearly marked UND RFP BC All proposals must be received via , no later than 5:00 pm CST Wednesday, January 10, 2018 (no exceptions will be made). Faxed and/or mail submitted applications will not be accepted. UND accepts no responsibility for non-receipt and delays in receipt caused by technological error/malfunction. Acceptance or non-acceptance of an application: The review panel reserves the right to accept or not accept any or all applications or parts of the application, and to waive formalities. 6

7 Reporting Requirements: An interim and a final online program report will be required from all grantees. Follow-up beyond the actual event or program is expected. Tuesday, December 12, 10:00-10:30am CST Wednesday, January 10, 2018 Thursday, February 1, 2018 Wednesday, August 15, 2018 Friday, February 15, 2019 IMPORTANT DATES Technical assistance conference call for interested applicants Call in number: Passcode: # Proposals must be received via by 5:00 pm CST Notification of awards Interim Report due Project must be completed, Final Report submitted, and funds expended For information on the grant or its application please contact: Kylie Nissen, Senior Project Coordinator Center for Rural Health, UND School of Medicine and Health Sciences kylie.nissen@med.und.edu 7

8 SAMPLE WORKPLAN Project: 5K Get Movin Fun Run/Walk Goal 1: Host a 5K run/walk Objective Activities Anticipated Outcome Measures Timeline Person(s) Responsible Plan a 5K benefit event Host the 5K Recognize all participants, volunteers, and sponsors Hold planning meetings with partners Advertise the 5K Process Registration Determine the course Conduct the required tasks to host the 5K -send thank you letters to the sponsors and volunteers -at the event thank the runners -put a thank you in the local newspapers -decide on structure of run -set registration fee -establish rules - establish route - website dedicated to the 5K created - ads placed in local and surrounding newspapers - flyers posted around town and surrounding towns -ad place on public TV station - local news stations report on the upcoming event and attend the event - registration forms collected - payments deposited -map out the course -contact law enforcement and get course approval and security volunteers -mark off the route -set-up water stations -conduct checkin/registration -handout shirts, numbers, and course maps The sponsors, volunteers, and participants will feel valued for their time and contributions to the event. -number of people participating in the planning meetings -number of times the ads were run in the newspaper, radio, and on television -event covered on the news -number of people that register for the event -number of registrations processed per day - time from payment received until deposited -law enforcement approval of established course - reported satisfaction with course -number of law enforcement volunteers -number of people that registered for the 5K -age and gender of participants -number of people who return for the second annual 5K January 1 April 15, April 15 July 3, April 15 July 3, May July 5-6, July 6-15, Planning committee members Eric Thompson, Communication s committee Good Care Health System Lacey Peterson, Matthew Omdahl Planning Committee, volunteers Don Goodstein Goal 2: Raise $8000 for local high school to resurface their track Objective Activities Anticipated Outcome Measures Timeline Person(s) Responsible Solicit sponsors -mail letters and send -assist with financing -number of February Erin Thompson, 8

9 Solicit volunteers Host training sessions Provide funds for the track resurfacing from the s -contact businesses in person - send s -contact people in person -put an ad in the local paper -run a radio ad -host weekly training sessions for those interested in participating in the 5K -charge a small fee -process all the income and expenses -present funds at the homecoming football game the event and publicizing it -by using volunteers we won t need to pay staff and will hold a successful event -Increase number of participants -Raise additional funds -raised money for the track resurfacing sponsors -amount of sponsorship donations -number of volunteers -amount saved by not having paid staff -number of people who attend -amount raised -raised at least $8000 May January May May-July September 13, Community Boosters Kris Johnson Lacey Peterson, Matthew Omdahl Principal John Steiger SAMPLE BUDGET SPREADSHEET EXPENSES TOTAL COST AMOUNT 1. Registration Fees Credit Card fees (5% + $120) $360 $360 REQUESTED FROM GRANT Website design/hosting $500 $250 $ Administration Duplicating maps, registration forms, $1,250 $1,250 course signs, pledge forms, thank you letters Postage $50 $50 3. Insurance Liability Insurance $500 $ Supplies Bottled water (750) $375 $375 Finish line banner $50 $50 Race-day shirts ($5/each) $2,000 $2,000 AMOUNT PROVIDED IN-KIND 9

10 Racer numbers ($0.40 each) $140 $140 Trophies $150 $ Advertising Newspaper ads $250 $250 Radio $75 $75 Television $250 $50 $200 Total $5,700 $5,000 $ SAMPLE BUDGET NARRATIVE 1. Registration Fees $ requested from grant Good Care Health System will be processing the registrations for the 5K and has agreed to do it with no administrative costs. The only costs that will be incurred are that required for accepting credit cards. The credit card company charges a flat rate of $120 plus 5% on each transaction. We estimate 185 transactions totaling $4,800 at 5% for a total of $240 plus the $120 flat rate = $360. There will be a cost of $500 to create and host the event s website. The service provider charges $250/year. This includes the fee for the domain name. The cost for the web developer to initially create the site is $250. We are only asking for the hosting portion of the costs to be paid through the grant. Sponsorships will be sought to cover the cost of web design. The website is necessary for both advertising purposes and for registration (registration and credit card payments will be taken online). 2. Administration $1, requested from grant The cost of design and printing of the (100) course signs, (600) course maps, (100) sponsor recognition signs, (100) sponsor request/pledge letters, (200) registration forms, (1000) advertisement flyers, (50) thank you letters, and any other printed materials are included in the duplicating costs. Charges for duplicating are $0.08/black and white copy and $0.13/color copy. Hundreds of flyers will be printed and posted in our town and surrounding communities. Ten large signs will be printed and laminated to hang in the gyms/football fields at school sporting events to advertise the 5K at a cost of approximately $60/sign. In addition to the costs of paper and ink for duplication, postage (approximately $60) will be an additional expense (sending 50 sponsor requests, 30 volunteer requests, and 50 thank you letters). 3. Insurance $ requested from grant It is required that we take out liability insurance for the event. First Rate Insurance, a local business in our community, has agreed to provide that insurance to us for $ Supplies $2, requested from grant Supplies needed for the actual race include bottles of water for the water stands stationed throughout the course and the finish line banner. Each racer will receive a shirt and a number as part of their registration fee ($30 registration fee for adults; $20 registration fee for youth kids under 16). Trophies will be given out to the first three places in each of the divisions: men s adult division, women s adult division, boy s youth division, and girl s youth division. 10

11 5. Advertising - $ requested from grant Advertising costs will be required for promoting the event via ads and public service announcements on television, radio, and in newspapers in the region. Sponsorships will be used to cover the costs of putting an ad in local newspapers for several weeks prior to the event. The radio station charges $75 and will air an ad for the 5K at least five times a day for two months. They gave us a deal and are only charging us for one of the two months that the ad will be aired. The cost to produce the TV ad will be $200. It is our plan to pay for the production costs through sponsorships. The $50 charge will be the fee that the television station charges to air the ad for three weeks (pay for two weeks at $25/week and get the third week free). All costs not received through the grant will be covered through sponsorships from businesses and community members. 11